Development and Validation of a Patient-Reported Experience Measure for Gastrointestinal Endoscopy: The Comprehensive Endoscopy Satisfaction Tool (CEST).

GOALS: We aimed to develop and validate a patient-reported experience measure for gastrointestinal (GI) endoscopy, the Comprehensive Endoscopy Satisfaction Tool that captures relevant domains that influence the patient's experience and identify factors that shape satisfaction. BACKGROUND: Patient-reported experience measures are used to capture specific quality aspects of health care services. GI endoscopic services are high-volume services, and there is a lack of specific, validated instruments to capture various domains that shape the patients' experience with routine clinical endoscopic services. STUDY: After an environmental scan and structured literature review, focus groups with patients were conducted to identify relevant factors influencing the patient experience with GI endoscopic services. After an initial validation in 101 patients undergoing routine GI endoscopies, the instrument was tested in 7800 patients. In addition, the influence of sociodemographic factors on global satisfaction was explored. RESULTS: The final version included 26 specific items plus 4 global ratings for preprocedure, experience on day of procedure, postprocedure care, and infrastructure. In addition, a global rating of the overall experience was included. Patient satisfaction was significantly higher in older patients (P<0.001) but not influenced by gender, nationality, marital status, education, or employment status. Interestingly, during periods of coronavirus disease-19-related service interruptions, the Net Promoter Score was significantly reduced (P<0.0001) providing evidence for the responsiveness of the instrument. CONCLUSIONS: The Comprehensive Endoscopy Satisfaction Tool is a valid measure for the patient experience with the various components of endoscopic services, allows for the identification of domains that impact on the patient experience and is a practical tool to compare patient satisfaction over time and across facilities.

A Single-Blind Study Testing the Preparation Accuracy of Bedside Precleaning Solutions Used for Flexible Endoscopes.

Endoscopy-related pathogen transmission may occur if microorganisms are spread from patient to patient by contaminated equipment. Effective and safe endoscope reprocessing includes bedside precleaning, mechanical cleaning, high-level disinfection, storage, and drying. The aim of this research study was to observe and report on the variation in practice regarding the use of detergent for bedside precleaning of flexible gastrointestinal endoscopes. Endoscopy nurses working in the endoscopy unit at the Princess Alexandra Hospital, Australia, prepared four samples of detergent solution as per normal routine. Twenty-nine nurses participated providing in total 116 samples. There was a significant variation in detergent concentration. The detergent concentration variated between 2.00 and 288.20 ml/L ( M = 34.55, SD = 39.21). Two samples revealed lower concentrations than required. More than 25% of the samples contained at least a 10 times higher concentration than required (>40 ml/L). Current practice of bedside precleaning of gastrointestinal endoscopes was not deemed safe or cost-effective as it did not guarantee an adequate concentration of detergent. More precise methods to establish the required concentration of the bedside precleaning solution were introduced to improve practice.

Patient Positioning Guidelines for Gastrointestinal Endoscopic Procedures.

Patient positioning during gastrointestinal endoscopic procedures has received minimal attention compared with surgical procedures performed in the surgical setting. However, prolonged endoscopic interventions on patients and the increasing requirement for general anesthesia have changed to need for patient positioning guidelines. The objective of this study was to test whether patient positioning guidelines for surgical procedures in surgical suites are suitable for gastrointestinal endoscopic procedures without negatively impacting safety and procedure duration. This was an observational feasibility study with volunteers of different body mass index categories. Volunteers were positioned in supine, lateral, and prone positions on an operating table and thereafter on an endoscopy stretcher and asked for comfort levels. Except for arm and head positioning in lateral and prone positions, it was possible to replicate the patient positioning guidelines. Alternative options were explored for the positioning of arms and head to optimize oral access. Besides minor adjustments, we were able to replicate the positioning guidelines and adhere to pressure and nerve injury prevention guidelines. Concept endoscopic patient positioning guidelines were developed. It is recommended to review the "swimmer's" position. Endoscopic patient positioning guidelines should become part of the National Practice Standards and education curriculum of endoscopy nurses.

An Evidence-based Approach Towards Targeted Patient Education to Improve Bowel Preparation for Colonoscopy.

GOALS AND BACKGROUND: Quality of bowel preparation is an important factor influencing adenoma detection. Patient education is believed to improve the quality of bowel preparation but might be resource-intensive. We aimed to (a) identify risk factors for failed bowel preparations and (b) develop and test the efficacy of a screening tool that allows to prospectively identify and target patients at increased risk. STUDY: Part 1: 76 consecutive outpatients with poor bowel preparation were compared with 76 age-matched and gender-matched outpatients with good preparation from the same procedure lists. Sociodemographic and clinical data were obtained from centralized databases. Univariate analysis and multivariate logistic regression was used to identify risk factors for poor bowel preparation. Part 2: on the basis of results of part 1, a screening tool for prospectively identifying patients at high risk was developed, and targeted education tested. RESULTS: We identified the use of opioids or other constipating agents and low socioeconomic status as risk factors for poor bowel preparation [odds ratio (OR)=2.88; 95% confidence interval (CI): 1.22-6.80 and OR=2.43; 95% CI: 1.25-4.72]. Diabetes, hypothyroidism, age, and gender were found to have no effect on quality. When education was provided only to patients at increased risk, the targeted approach did not negatively affect the proportion of poor preparation (OR=6.12%; 95% CI: 4.79%-7.78% vs. OR=5.73%; 95% CI: 4.61%-7.10%). CONCLUSIONS: Poor bowel preparation is associated with specific risk factors. Identifying and specifically targeting education at patients with these risk factors appears to facilitate more efficient use of education resources in endoscopy.

An in vitro and clinical dose-finding study of antifoaming effects of simethicone during colonoscopy.

Simethicone is an antifoaming agent frequently added to endoscopic rinse solutions but has recently been implicated as a risk factor for transmission of infections due to the formation of simethicone deposits within scope channels. Since the build-up of residue is likely dose-related, the smallest effective dose of simethicone should be used but there are no data available on the effective dose. Thus, we conducted a dose-finding study in an "in vitro bubble model" to determine the appropriate simethicone dose. Six 100-mL test tubes were filled with a 1% (v/v) solution of kitchen detergent (Fairy®, Procter & Gamble, London, England) in water for irrigation (Baxter®, Sydney, Australia). One test tube served as the control, while different doses of simethicone (Infacol®, Nice Pak, Melbourne, Australia) were added to the other five tubes (0.02, 0.2, 2.0, 20, and 200 mg/100 mL). Oxygen was streamed for 30 s into the test tubes at a rate of 2 L/min. After 10 s, photographs were taken and the visible bubbles were semi-quantitatively rated by independent assessors blinded to the dosing of simethicone. Simethicone at doses of 2 mg/100 mL had no appreciable antifoaming effect, whereas concentrations ≥ 20 mg/100 mL were sufficient to suppress bubble formation. This is substantially lower compared with frequently used doses of up to 200 mg/100 mL. Subsequently, we tested the lower simethicone dose with previously used higher doses, in 1475 and 1340 patients, respectively. We found it to have no impact on polyp detection with a rate of 56.7% (54.2-59.3% [95% CI]) at the lower dose and 56.5% (53.8-59.1% [95% CI]) at the higher dose.

Correction to: An in vitro and clinical dose-finding study of antifoaming effects of simethicone during colonoscopy.

In the above article, due to probable typo error with the picture and legend, the correct Fig. 1 and the Legend to the Fig. 1 is printed here.

High fatigue scores among older Dutch nurse anesthetists.

In The Netherlands, hospital care production pressure recently increased substantially, while the number of nurse anesthetists available did not match this rise. The longtime existing norm of no night shifts for nurses beyond the age of 55 years was increased to age 57 to meet the demand for more nurse anesthetists. In this pilot study, we aimed to determine the level of fatigue and its correlation with demographic items among this category of employees. A validated questionnaire was distributed to all Dutch nurse anesthetists above 50 years of age working in Dutch hospitals, which asked for their level of fatigue. The Checklist Individual Strength Questionnaire was used to measure fatigue. Overall, 105 of 115 potential participants completed the questionnaire (response rate, 91%). The mean scores (+/- standard deviation) were as follows: total fatigue, 81.3 +/- 8.3; subjective fatigue, 31.4 +/- 3.2; physical activity, 13.1 +/- 2.2; motivation, 16.8 +/- 2.6; and concentration, 20.0 +/- 3.8. No correlation could be demonstrated between demographic characteristics and fatigue. Dutch nurse anesthetists above the age of 50 years show a high fatigue score and therefore need special attention to prevent them from harmful physical and psychological effects and to sustain maximal patient safety.

No differences in job perceptions amongst Dutch nurse anaesthetists with and without nursing background.

BACKGROUND: In the Netherlands, the employment as a "nurse anaesthetist" is comparable to that of a registered nurse anaesthetist in the Scandinavian countries and Poland. However, the Dutch healthcare system employs nurse anaesthetists both with and without nursing backgrounds. This study has investigated whether a nursing background influences the attitudes and perceptions of nurse anaesthetists in the Netherlands. METHODS: A survey was distributed to all nurse anaesthetists working in Dutch hospitals to discover differences in their perceptions of their work context, job satisfaction, and work climate, as well as health and turnover intention. The questionnaire also sought basic information on socio-demographic factors and psychosomatic symptoms. Descriptive statistics, factor analyses and independent T-tests were computed. RESULTS: Overall 923 of a total of 2,000 questionnaires were completed and analysed (response rate of 46%). Independent T-tests showed no significant differences between nurse anaesthetists with and those without nursing backgrounds in all the areas examined. CONCLUSION: Dutch nurse anaesthetists with and without nursing backgrounds reported similar perceptions of and information about their work context, job satisfaction, work climate, psychosomatic symptoms, burnout, sickness absence, general health and turnover intention. Both academic tracks appeared to produce individuals who functioned similarly as professionals.

Work climate related to job satisfaction among Dutch nurse anesthetists.

Finding ways to retain nurse anesthetists in the profession to meet the increasing demands of the healthcare system is of paramount importance. The present study investigates the relationship between work climate and job satisfaction among Dutch nurse anesthetists. A questionnaire was distributed to Dutch nurse anesthetists to assess their perceptions of their work climates, and their levels of job satisfaction. Multiple regression analyses were performed to obtain the predictive value of work climate for job satisfaction. All of the work climate characteristics had statistically significant correlations to job satisfaction, and explained 20% of the variance in job satisfaction. To achieve a higher level of job satisfaction among nurse anesthetists, it is necessary to improve some essential work climate characteristics, such as: (1) making the nurse anesthetist feel an important part of the organization's mission statement, (2) discussing progress at work, (3) giving recognition for delivered work, (4) encouraging development, and (5) providing sufficient opportunities to learn and to grow.

Understanding nurse anesthetists' intention to leave their job: how burnout and job satisfaction mediate the impact of personality and workplace characteristics.

BACKGROUND: The retention of nurse anesthetists is of paramount importance, particularly in view of the fact that the health care workforce is shrinking. Although many health care providers find their work satisfying, they often consider leaving their jobs because of the stress. Are there ways to improve this situation? PURPOSE: This study investigated how work environment characteristics and personality dimensions relate to burnout and job satisfaction and ultimately to turnover intention among Dutch nurse anesthetists. METHODOLOGY: An online self-reporting questionnaire survey was performed among Dutch nurse anesthetists. The questionnaire included scales to assess personality dimensions, work climate, work context factors, burnout, job satisfaction, and turnover intention. The research model stated that personality dimensions, work climate, and work context factors, mediated by burnout and job satisfaction, predict turnover intention. Structural equation modeling was used to test the research model. FINDINGS: Nine hundred twenty-three questionnaires were completed (46% response rate). Burnout mediated the relationship between personality dimensions and turnover intention; job satisfaction mediated the relationship of work climate and work context factors to turnover intention. PRACTICE IMPLICATIONS: To retain nursing staff and to maintain adequate staff strength, it is important to improve job satisfaction by creating a positive work climate and work context and to prevent burnout by selecting the most suitable employees through personality assessment.

Composition of the anaesthesia team: a European survey.

BACKGROUND AND OBJECTIVE: The anaesthesia workforce in Europe is understaffed and may not meet the growing demands of surgery. In many European countries where responsibilities can be identified and a varying degree of task substitution occurs, the anaesthesia service is provided by a team of physician and nonphysician anaesthesia members. This study assesses the availability, as well as the roles and functions, of nonphysician anaesthesia team members in European countries. METHODS: A survey was carried out to examine differences in anaesthesia practices and the strength of the anaesthesia workforce in Europe. A questionnaire, seeking information about perioperative anaesthesia input by nonphysician anaesthesia team members, was sent to all the national representatives of the Union of European Medical Specialists Anaesthesiology section and the International Federation of Nurse Anaesthetists. RESULTS: The responses to the questionnaire revealed that each European country has its own unique type of nonphysician anaesthesia team member and the roles of these vary substantially. Their levels of organisation vary from country to country and whereas nurse anaesthetists are often well organised, circulation nurses are not. CONCLUSION: The present study demonstrated the heterogeneity and variety of anaesthesia practices throughout Europe. Standardisation of the training and practice of European nurse anaesthetists is desirable for patient safety and quality of care if they seek to work in more than one European country. Those countries that anticipate a shortfall in the supply of anaesthesiologists should examine working models from other countries that currently work with fewer physicians and more nurse anaesthetists.